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Cohen SB, Dabi Y, Burke Y, Mamadov N, Manoim N, Mashiach R, Berkowitz E, Bouaziz J, Nicolas-Boluda A, Porpora MG, Ziv-Baran T. Laparoscopic nerve lysis for deep endometriosis improves quality of life and chronic pain levels: A pilot study. J Gynecol Obstet Hum Reprod 2024; 53:102778. [PMID: 38570115 DOI: 10.1016/j.jogoh.2024.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To assess the benefit of surgical management of patients with endometriosis infiltrating pelvic nerves in terms of pain, analgesic consumption, and quality of life (QOL). METHODS We conducted a retrospective cohort study In an Endometriosis referral center at a tertiary care university affiliated medical center. Patients diagnosed with endometriosis that underwent laparoscopic neurolysis for chronic pain were included. Patients rated their pain before and after surgery and differentiated between chronic pain and acute crises. Patients were requested to maintain a record of analgesic consumption and to evaluate their quality-of-life (QOL). RESULTS Of the 21 patients in our study 15 (71.5 %) had obturator nerve involvement, 2 (9.5 %) had pudendal nerve involvement and 4 (19 %) had other pelvic nerve involvement. Median postoperative follow - up was of 8 months. All but 2 patients (9.6 %) had significant chronic pain improvement with a mean decrease of VAS of 3.05 (±2.5). Analgesic habits changed postoperatively with a significant decrease of 66 % of patients' daily consumption of any analgesics. Surgery improved QOL in 12 cases (57.1 %) and two patients (9.6 %) completely recovered with a high QOL. CONCLUSION Neurolysis and excision of endometriosis of pelvic nerves could results in significant improvement of quality of life.
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Affiliation(s)
- Shlomo B Cohen
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yohann Dabi
- Sorbonne University,Department of obstetrics and gynecology Tenon Hospital (AP-HP), Paris, France.
| | - Yechiel Burke
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nicole Mamadov
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Manoim
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Berkowitz
- Endometriosis and Chronic Pelvic Pain Unit, Department of obstetrics and gynecology, Sheba Medical Center, Ramat Gan, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jerome Bouaziz
- Department of Research, One Clinic, 25 Boulevard Pasteur, 75015 Paris, France
| | - Alba Nicolas-Boluda
- Department of Research, One Clinic, 25 Boulevard Pasteur, 75015 Paris, France
| | | | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shirafkan H, Moher D, Mirabi P. The reporting quality and spin of randomized controlled trials of endometriosis pain: Methodological study based on CONSORT extension on abstracts. PLoS One 2024; 19:e0302108. [PMID: 38696383 PMCID: PMC11065215 DOI: 10.1371/journal.pone.0302108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE To assess the reporting quality of published RCT abstracts regarding patients with endometriosis pelvic pain and investigate the prevalence and characteristics of spin in these abstracts. METHODS PubMed and Scopus were searched for RCT abstracts addressing endometriosis pelvic pain published from January 1st, 2010 to December 1st, 2023.The reporting quality of RCT abstracts was assessed using the CONSORT statement for abstracts. Additionally, spin was evaluated in the results and conclusions section of the abstracts, defined as the misleading reporting of study findings to emphasize the perceived benefits of an intervention or to confound readers from statistically non-significant results. Assessing factors affecting the reporting quality and spin existence, linear and logistic regression was used, respectively. RESULTS A total of 47 RCT abstracts were included. Out of 16 checklist items, only three items including objective, intervention and conclusions were sufficiently reported in the most abstracts (more than 95%), and none of the abstracts presented precise data as required by the CONSORT-A guidelines. In the reporting quality of material and method section, trial design, type of randomization, the generation of random allocation sequences, the allocation concealment and blinding were most items identified that were suboptimal. The total score for the quality varied between 5 and 15 (mean: 9.59, SD: 3.03, median: 9, IQR: 5). Word count (beta = 0.015, p-value = 0.005) and publishing in open-accessed journals (beta = 2.023, p-value = 0.023) were the significant factors that affecting the reporting quality. Evaluating spin within each included paper, we found that 18 (51.43%) papers had statistically non-significant results. From these studies, 12 (66.66%) had spin in both results and conclusion sections. Furthermore, the spin intensity increased during 2010-2023 and 38.29% of abstracts had spin in both results and conclusion sections. CONCLUSION Overall poor adherence to CONSORT-A was observed, with spin detected in several RCTs featuring non-significant primary endpoints in obstetrics and gynecology literature.
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Affiliation(s)
- Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - David Moher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Parvaneh Mirabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women's Health. Am J Obstet Gynecol 2023; 229:536.e1-536.e20. [PMID: 37499990 DOI: 10.1016/j.ajog.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Endometriosis has been linked to higher rates of a variety of symptoms; however, the findings from longitudinal studies are scarce and inconsistent. OBJECTIVE This study aimed to examine the association between endometriosis and common symptoms in a prospective cohort study. STUDY DESIGN This study included 7606 women born from 1973 to 1978 using data from the Australian Longitudinal Study on Women's Health that were collected every 3 years from 2009 to 2018. We identified women with endometriosis based on self-reported incidence from each survey and linked administrative health data. At each survey, women also completed a checklist on the presence of 24 symptoms. Generalized estimating equations for multinomial responses were used for analyses. RESULTS Women with endometriosis had significantly more menstrual symptoms than those without endometriosis with an adjusted odds ratio (95% confidence interval) of 3.61 (3.11-4.19) for severe period pain, 2.40 (2.10-2.74) for heavy menstrual bleeding, 1.76 (1.52-2.03) for irregular bleeding, and 1.52 (1.32-1.76) for premenstrual tension. They also had higher odds of mental health problems with adjusted odds ratios of 1.67 (1.39-2.01) for depression and 1.59 (1.24-2.03) for anxiety and higher odds of allergies and nonspecific symptoms with adjusted odds of 1.62 (1.40-1.89) for allergies or hay fever or sinusitis, 1.79 (1.56-2.05) for severe tiredness, 1.56 (1.35-1.81) for sleep difficulty, and 1.77 (1.37-2.18) for palpitations. There was also a strong association with other forms of pain with an adjusted odds ratio of 1.76 (1.53-2.04) for backpain, 1.50 (1.29-1.74) for headaches or migraines, and 1.65 (1.41-1.93) for stiff or painful joints. Women with endometriosis also had increased odds of developing bowel and urinary symptoms with an adjusted odds ratio (95% confidence interval) of 1.67 (1.35-2.08) for constipation, 1.46 (1.12-1.90) for hemorrhoids or piles, 1.25 (1.03-1.52) for indigestion or heartburn, 2.80 (1.71-4.58) for urine burn or stings, and 1.37 (1.03-1.82) for vaginal discharge or irritation. The association between each symptom and endometriosis was similar whether endometriosis was surgically confirmed or clinically suspected. No association was found between endometriosis and the risk for skin problems, leaking urine, or breathing difficulty. CONCLUSION This study suggests that women with endometriosis are more likely to report not only menstrual symptoms but are also at an increased risk for mental health problems, other pain symptoms, bowel and urinary symptoms, and nonspecific symptoms, such as severe tiredness and difficulty sleeping.
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Affiliation(s)
- Dereje G Gete
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Doust
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sally Mortlock
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Grant Montgomery
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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Neuditschko B, Leibetseder M, Brunmair J, Hagn G, Skos L, Gerner MC, Meier-Menches SM, Yotova I, Gerner C. Epithelial Cell Line Derived from Endometriotic Lesion Mimics Macrophage Nervous Mechanism of Pain Generation on Proteome and Metabolome Levels. Biomolecules 2021; 11:1230. [PMID: 34439896 PMCID: PMC8393596 DOI: 10.3390/biom11081230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a benign disease affecting one in ten women of reproductive age worldwide. Although the pain level is not correlated to the extent of the disease, it is still one of the cardinal symptoms strongly affecting the patients' quality of life. Yet, a molecular mechanism of this pathology, including the formation of pain, remains to be defined. Recent studies have indicated a close interaction between newly generated nerve cells and macrophages, leading to neurogenic inflammation in the pelvic area. In this context, the responsiveness of an endometriotic cell culture model was characterized upon inflammatory stimulation by employing a multi-omics approach, including proteomics, metabolomics and eicosanoid analysis. Differential proteomic profiling of the 12-Z endometriotic cell line treated with TNFα and IL1β unexpectedly showed that the inflammatory stimulation was able to induce a protein signature associated with neuroangiogenesis, specifically including neuropilins (NRP1/2). Untargeted metabolomic profiling in the same setup further revealed that the endometriotic cells were capable of the autonomous production of 7,8-dihydrobiopterin (BH2), 7,8-dihydroneopterin, normetanephrine and epinephrine. These metabolites are related to the development of neuropathic pain and the former three were found up-regulated upon inflammatory stimulation. Additionally, 12-Z cells were found to secrete the mono-oxygenated oxylipin 16-HETE, a known inhibitor of neutrophil aggregation and adhesion. Thus, inflammatory stimulation of endometriotic 12-Z cells led to specific protein and metabolite expression changes suggesting a direct involvement of these epithelial-like cells in endometriosis pain development.
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Affiliation(s)
- Benjamin Neuditschko
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
- Department of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 42, 1090 Vienna, Austria
| | - Marlene Leibetseder
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
| | - Julia Brunmair
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
| | - Gerhard Hagn
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
| | - Lukas Skos
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
| | - Marlene C. Gerner
- Division of Biomedical Science, University of Applied Sciences, FH Campus Wien, Favoritenstraße 226, 1100 Vienna, Austria;
| | - Samuel M. Meier-Menches
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
- Department of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 42, 1090 Vienna, Austria
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria
| | - Iveta Yotova
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria;
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria; (B.N.); (M.L.); (J.B.); (G.H.); (L.S.); (S.M.M.-M.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, Waehringer Straße 38, 1090 Vienna, Austria
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Merlot B, Ploteau S, Abergel A, Rubob C, Hocke C, Canis M, Fritel X, Roman H, Collinet P. [Extragenital endometriosis: Parietal, thoracic, diaphragmatic and nervous lesions. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530553 DOI: 10.1016/j.gofs.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient.
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Affiliation(s)
- B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France.
| | - S Ploteau
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital mère-enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Abergel
- Médecine de la reproduction, clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France
| | - C Rubob
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor-d'Aquitaine, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
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Bove GM. A model for radiating leg pain of endometriosis. J Bodyw Mov Ther 2016; 20:931-936. [PMID: 27814877 DOI: 10.1016/j.jbmt.2016.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 01/03/2023]
Abstract
Endometriosis is a prevalent female health disorder that often leads to back pain and radiating leg pain. Patients with such pain often seek care from multiple health care professionals, including manual therapists. We hypothesized that endometrioma can induce nerve inflammation thus the radiating leg pain that often accompanies endometriosis. To model sciatic endometriosis in female Wistar rats, a section of uterine horn was autotransplanted to the sciatic nerve. Uterus sections with the endometrium removed and autotransplanted to the sciatic nerve served as controls. After 1, 3, and 15 months the nerves were harvested and processed for immune cell presence and for neural elements. Control nerves were harvested after 4 months. All autotransplants survived, resulting in a fusion of the uterus sections to the nerves. Macroscopically, turgid cysts apposed to the nerves characterized the complexes. Microscopically, the complexes contained recruited macrophages, indicating persistent inflammation, and were innervated by small diameter axons. Only 1 of 8 control rats developed a small cyst, presumably due to residual endometrium. The persistent immune response and innervation suggest the nerve-uterus complexes as sources of inflammation and persistent neural discharge, and thus pain. This model could shed light upon the radiating leg pain that often accompanies endometriosis. Manual therapists should be aware of the possibility of endometriosis causing symptoms and examination findings that mimic musculoskeletal etiologies.
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Affiliation(s)
- Geoffrey M Bove
- University of New England College of Osteopathic Medicine, Biddeford, ME, USA.
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Rothmund R, Scharpf M, Tsaousidis C, Planck C, Enderle MD, Neugebauer A, Kroeker K, Nuessle D, Fend F, Brucker S, Kraemer B. A Prospective Randomized Experimental Study to Investigate the Eradication Rate of Endometriosis after Surgical Resection versus Aerosol Plasma Coagulation in a Rat Model. Int J Med Sci 2016; 13:187-94. [PMID: 26941579 PMCID: PMC4773283 DOI: 10.7150/ijms.14246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the eradication rate of endometriosis after surgical resection (SR) vs. thermal ablation with aerosol plasma coagulation (AePC) in a rat model. METHODS In this prospective, randomized, controlled, single-blinded animal study endometriosis was induced on the abdominal wall of 34 female Wistar rats. After 14 days endometriosis was either removed by SR or ablated by AePC. 14 days later the rats were euthanized to evaluate the eradication rate histopathologically. Intervention times were recorded. RESULTS Eradication rate of endometriosis after 14 days did not significantly differ between AePC and SR (p=0.22). Intervention time per endometrial lesion was 22.1 s for AePC and 51.8 s for SR (p<0.0001). CONCLUSIONS This study compares the eradication rate of the new aerosol plasma coagulation device versus standard surgical resection of endometriosis in a rat model. Despite being a thermal method, AePC showed equality towards SR regarding eradication rate but with significantly shorter intervention time.
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Affiliation(s)
- Ralf Rothmund
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | - Marcus Scharpf
- 2. Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076 Tuebingen, Germany (Director: Prof. F. Fend)
| | - Christos Tsaousidis
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | - Constanze Planck
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | | | | | - Kristin Kroeker
- 3. Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tuebingen, Germany
| | - Daniela Nuessle
- 3. Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tuebingen, Germany
| | - Falko Fend
- 2. Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076 Tuebingen, Germany (Director: Prof. F. Fend)
| | - Sara Brucker
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | - Bernhard Kraemer
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
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Chen S, Xie W, Strong JA, Jiang J, Zhang JM. Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats. Eur J Pain 2015; 20:1044-57. [PMID: 26688332 DOI: 10.1002/ejp.827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endometriosis is a common cause of pain including radicular pain. Ectopic endometrial tissue may directly affect peripheral nerves including the sciatic, which has not been modelled in animals. METHODS We developed a rat model for sciatic endometriosis by grafting a piece of autologous uterine tissue around the sciatic nerve. Control animals underwent a similar surgery but received a graft of pelvic fat tissue. RESULTS The uterine grafts survived and developed fluid-filled cysts; the adjacent nerve showed signs of swelling and damage. Mechanical and cold hypersensitivity and allodynia of the ipsilateral hindpaw developed gradually over the first 2 weeks after the surgery, peaked at 2-5 weeks, and was almost resolved by 7 weeks. Control animals showed only minor changes in these pain behaviours. Histological signs of inflammation in the uterine graft and in the adjacent nerve were observed at 3 weeks but were resolving by 7 weeks. In vivo fibre recording showed increased spontaneous activity, especially of C-fibres, in sciatic nerve proximal to the uterine graft. Several pro-inflammatory cytokines including interluekin-18, VEGF, fractalkine, and MIP-1α, were elevated in the uterine graft plus sciatic nerve samples, compared to samples from normal nerve or nerve plus fat graft. Growth associated protein 43 (GAP43), a marker of regenerating nerve fibres, was observed in the adjacent sciatic nerve as well as in the uterine graft. CONCLUSIONS This model shared many features with other rat models of endometriosis, but also had some unique features more closely related to neuropathic pain models. WHAT DOES THIS STUDY/REVIEW ADD Some especially painful forms of endometriosis are essentially neuropathic, because peripheral nerves are directly affected by nearby ectopic endometrial tissue. We modelled endometriosis by implanting autologous uterine tissue around rat sciatic nerve. We observed mechanical and cold pain behaviours along with signs of inflammation and nerve damage and increased pro-inflammatory cytokines at the implant site. Pain behaviours correlated with signs of nerve inflammation and damage rather than with cyst survival.
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Affiliation(s)
- S Chen
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China.,Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - W Xie
- Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - J A Strong
- Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - J Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China
| | - J-M Zhang
- Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
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Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health 2015; 15:39. [PMID: 25952159 PMCID: PMC4450847 DOI: 10.1186/s12905-015-0196-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/24/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health. METHODS A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence. RESULTS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking. CONCLUSION Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management.
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Affiliation(s)
- Hedyeh Riazi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Saeideh Ziaei
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Jalal-e Al Ahmad Highway, P.O Box 14115-331, Tehran, Iran.
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, P.O Box 13185-1488, Tehran, Iran.
- Faculty of Humanity Sciences, University of Science & Culture, ACECR, Tehran, Iran.
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